Depression and mania

1. DEPRESSION AND
MANIA
BY
A.PAVITHRA

2. DEPRESSION
• DEFINITION: It is a group of conditions associated with the
elevation or lowering of a persons mood.
• Depression is the most common mood disorder affecting
approximately 20 million people each year.

3. Factors causing depression
• Generally there is no particular evidence or cause for depression.
• But some factors that may contribute to its development are:
• Psychological
• Biological
• Environment

4. • Some evidences also shows that some people with a genetic predisposition to
major depression vulnerable to the disorder.
• But however not everyone with a family history develops depression.
• Some life events that may trigger episodes of depression:
• Death of a loved one
• Major loss or change
• Chronic stress

5. • Alcohol and drug abuse
• medications

6. Types of depression
• MAJOR DEPRESSION: symptoms of depression that last for more than 2weeks.
• DYSTHYMIA: a low mood occurring for at least 2 years along with at least two
other symptoms of depression.
• BIPOLAR DISORDER OR MANIC – DEPRESSIVE ILLNESS: cycles of mood
swings from mania to depression occur.
• SEASONAL AFFECTIVE DISORDER: depression during the winter months
when daylength is short.

7. • POST PARTUM DEPRESSION: Can occur soon after child birth .
• Hormonal and life style changes.
• A TYPICAL DEPRESSION: Improved mood when exposed to pleasurable
positive events
• Increased weight, oversleeping, anxiety, rejection sensitivity.

8. EPIDEMIOLOGY
• Globally more than 350 million people of all ages suffer from depression. (WHO)
• For the age group 15-44 major depression is the leading cause of disability in the
U.S.
• Women are nearly twice as likely to suffer from a major depressive disorder than
men .
• With age the symptoms of depression become even more severe.
• About thirty percent of people with depressive illness attempt suicide.

9. ETIOLOGY
• Genetic cause
• • Environmental factors
• • Biochemical factors : Biochemical theory of depression postulates a deficiency
of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and
dopamine).
• • Dopaminergic activity : reduced in case of depression, over activity in mania.
• • Endocrine factors

10. • - hypothyroidism, cushing’s syndrome etc
• Abuse of Drugs or Alcohol
• • Hormone Level Changes
• • Physical illness and side effects of medications

12. PATHOPHYSIOLOGY
• DOPAMINE HYPOTHESIS:
• In CNS the neural circuits gets constricted
• |
• Dopaminergic decreased production or dopamine easy uptake
• less dopamine levels in CNS
• Depression

13. • The Serotonin-only Hypothesis - emphasizes the role
of serotonin in depression and downplays noradrenaline.
• - But the serotonin-only theory has shortcomings:
• - it does not explain why there is a delay in onset of clinical
relief
• - it does not explain the role of NA in depression

14. • PERMISSIVE HYPOTHESIS:
• It suggest that low levels of serotonin [5-HT] have a permissive role in the
development of affective disorder.
• The causative neurotransmitter is nor-adrenaline deficit of which causes
depression and functional excess causes mania.
• Increasing 5-HT level in brain corrects the affective disorders by removing the
permissive effect of low 5-HT.

15. • NEUROENDOCRINE HYPOTHESIS:
• Their mechanism of action focus on the monoamine hypothesis for depression
which centers on the disruption of serotonergic, noradrenergic, and
dopaminergic neurotransmission in the brain.
• It includes changes in the hypothalamic – pituitary-adrenal and thyroid axes in
growth hormone and prolactin secrection.

16. RISK FACTORS
• Thyroid diseases
• Diabetes
• Carcinoma
• Pernicious anaemia
• Neurological disorders
• Viral illness
• Heart diseases

17. TREATMENT
• MAO INHIBITORS: Isocarboxazid , phenelzine , tranylcypromine
• TCAs [ Tricyclic antidepressants]:
• Selective serotonin reuptake inhibitors
• A typical antidepressants : venlafaxine , duloxetine
• NON PHARMACOLOGICAL THERAPY:
• Stress reduction
• Social support

18. • Sufficient sleep
• psycotherapy

19. MANIA

20. MANIA
• DEFINITION: A mental illness marked by periods of great
excitement or euphoria , delusions, and overactivity.

21. SIGNS AND SYMPTOMS
• Increased activity, energy, or agitation
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Agressiveness
• Flight of ideas
• Weight loss

22. TREATMENT
• MOOD STABILIZERS: lithium , carbamazepine
• ANTICONVULSANTS; gabapentine , lamotrigine
• BENZODIAZEPINES: lorazepam , clonazepam